Supporting Provider Services

NPI #1114393527 in Oak Creek, Wisconsin

Provider Information

NPI Number: 1114393527
Entity Type: Organization
Organization Name: Supporting Provider Services
Primary Specialty: Respite Care - Respite Care, Physical Disabilities, Child
Enumeration Date: Aug 19, 2015
Last Updated: Aug 19, 2015

Practice Location

Address: 8330 S WYNONA CT
City: Oak Creek
State: Wisconsin
ZIP Code: 53154-2740
Phone: (262) 527-1282

Authorized Official

Name: THERESA BUFORD
Title: VOCATIONAL REHABILITATION
Phone: (262) 527-1282

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Respite Care - Respite Care, Physical Disabilities, Child — Respite Care, Physical Disabilities, Child	385HR2065X	Primary

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